Does Weight Loss Increase Suicide Risk?

More than 50 years ago, Albert Stunkard described “dieting depression”, a finding subsequently confirmed over the years by other investigators. In extreme cases this adverse effect of dieting or weight loss on mood can increase suicidal ideation and may well increase the risk of suicide in some individuals.

Thus, according to a new study just published in OBESITY last month, Lucy Faulconbridge and colleagues (including Stunkard!) from the University of Pennsylvania, Philadelphia, PA, weight loss in some individuals may promote depression and suicidal ideation.

This study, examined changes in symptoms of depression in 194 obese participants in a 1-yr randomized trial of lifestyle modification and sibutramine. While mean scores on the Beck Depression Inventory declined (showing improved mood) across all groups, around 14% of participants across all groups reported potentially alarming increases (5 or more points) in symptoms of depression at week 52. These patients also lost significantly less weight than the rest of the participants.

While the baseline prevalence of suicidal ideation was 3.6%, seven new cases of suicidal ideation were observed during the year, with three cases even with lifestyle modification alone.

Thus, there appears to be an important minority of obese patients, who respond adversely to weight loss with clear signs of depression and even suicidal ideation. Interestingly, increasing suicidality has also been noted in previous studies of bariatric surgery (despite a marked reduction in all cause mortality).

These findings may have important clinical implications:

– We may need to be more careful in recommending weight loss to people with depression and/or past history of suicidal ideation or attempts.

– All individuals undergoing weight loss should be carefully monitored for deterioration in mood and instructed to seek appropriate counseling immediately upon experiencing suicidal thoughts.

– Public health recommendations to lose weight should be balanced against possible negative effects of weight loss attempts on mood.

Or, as the authors conclude:

These findings suggest that careful study is needed of the behavioral, neuroendocrine, and psychological effects of weight loss in obese patients with current depressive disorders, as well as in persons with a history of these and other psychiatric conditions.

Thus, while researchers and clinicians must take care to protect the small minority of individuals who may be at risk of experiencing adverse psychiatric complications with weight loss, they must also identify the conditions under which obese individuals with significant psychiatric complications can safely undertake weight reduction.

No one ever said obesity treatment was easy!

Edmonton, Alberta